Healthcare Provider Details

I. General information

NPI: 1245793272
Provider Name (Legal Business Name): EVAN WILHELM OSTERMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N MEADOWS DR
GROVE CITY OH
43123-2546
US

IV. Provider business mailing address

1020 SANSOM ST STE 1651B
PHILADELPHIA PA
19107-5002
US

V. Phone/Fax

Practice location:
  • Phone: 614-663-4550
  • Fax: 614-663-4555
Mailing address:
  • Phone: 215-955-9837
  • Fax: 215-955-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT020294
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: